For the sake of convenience: Commercial sources of prebiotic fibers

Our efforts to obtain prebiotic fibers/resistant starches, as discussed in the Cureality Digestive Health Track, to cultivate healthy bowel flora means recreating the eating behavior of primitive humans who dug in the dirt with sticks and bone fragments for underground roots and tubers, behaviors you can still observe in extant hunter-gatherer groups, such as the Hadza and Yanomamo. But, because this practice is inconvenient for us modern folk accustomed to sleek grocery stores, because many of us live in climates where the ground is frozen much of the year, and because we lack the wisdom passed from generation to generation that helps identify which roots and tubers are safe to eat and which are not, we rely on modern equivalents of primitive sources. Thus, green, unripe bananas, raw potatoes and other such fiber sources in the Cureality lifestyle.

There is therefore no need to purchase prebiotic fibers outside of your daily effort at including an unripe green banana, say, or inulin and fructooligosaccharides (FOS), or small servings of legumes as a means of cultivating healthy bowel flora. These are powerful strategies that change the number and species of bowel flora over time, thereby leading to beneficial health effects that include reduced blood sugar and blood pressure, reduction in triglycerides, reduced anxiety and improved sleep, and reduced colon cancer risk.

HOWEVER, convenience can be a struggle. Traveling by plane, for example, makes lugging around green bananas or raw potatoes inconvenient. Inulin and FOS already come as powders or capsules and they are among the options for a convenient, portable prebiotic fiber strategy. But there are others that can be purchased. This is a more costly way to get your prebiotic fibers and you do not need to purchase these products in order to succeed in your bowel flora management program. These products are therefore listed strictly as a strategy for convenience.

Most perspectives on the quality of human bowel flora composition suggest that diversity is an important feature, i.e., the greater the number of species, the better the health of the host. There may therefore be advantage in varying your prebiotic routine, e.g., green banana on Monday, inulin on Tuesday, PGX (below) on Wednesday, etc. Beyond providing convenience, these products may introduce an added level of diversity, as well.

Among the preparations available to us that can be used as prebiotic fibers:

PGX

While it is billed as a weight management and blood sugar-reducing product, the naturally occurring fiber--α-D-glucurono-α-D-manno-β-D-manno- β-D-gluco, α-L-gulurono-β-D mannurono, β-D-gluco-β- D-mannan--in PGX also exerts prebiotic effects (evidenced by increased fecal butyrate, the beneficial end-product of bacterial metabolism). PGX is available as capsules or granules. It also seems to exert prebiotic effects at lower doses than other prebiotic fibers. While I usually advise reaching 20 grams per day of fiber, PGX appears to exert substantial effects at a daily dose of half that quantity. As with all prebiotic fibers, it is best to build up slowly over weeks, e.g., start at 1.5 grams twice per day. It is also best taken in two or three divided doses. (Avoid the PGX bars, as they are too carb-rich for those of us trying to achieve ideal metaobolic health.)

Prebiotin

A combination of inulin and FOS available as powders and in portable Stick Pacs (2 gram and 4 gram packs). This preparation is quite costly, however, given the generally low cost of purchasing chicory inulin and FOS separately.

Acacia

Acacia fiber is another form of prebiotic fiber.  RenewLife and NOW are two reputable brands.

Isomalto-oligosaccharides

This fiber is used in Quest bars and in Paleo Protein Bars. With Quest bars, choose the flavors without sucralose, since it has been associated with undesirable changes in bowel flora.

There you go. It means that there are fewer and fewer reasons to not purposefully cultivate healthy bowel flora and obtain all the wonderful health benefits of doing so, from reduced blood pressure, to reduced triglycerides, to deeper sleep.

Disclaimer: I am not compensated in any way by discussing these products.

How Not To Have An Autoimmune Condition


Autoimmune conditions are becoming increasingly common. Estimates vary, but it appears that at least 8-9% of the population in North America and Western Europe have one of these conditions, with The American Autoimmune Related Diseases Association estimating that it’s even higher at 14% of the population.

The 200 or so autoimmune diseases that afflict modern people are conditions that involve an abnormal immune response directed against one or more organs of the body. If the misguided attack is against the thyroid gland, it can result in Hashimoto’s thyroiditis. If it is directed against pancreatic beta cells that produce insulin, it can result in type 1 diabetes or latent autoimmune diabetes of adults (LADA). If it involves tissue encasing joints (synovium) like the fingers or wrists, it can result in rheumatoid arthritis. It if involves the liver, it can result in autoimmune hepatitis, and so on. Nearly every organ of the body can be the target of such a misguided immune response.

While it requires a genetic predisposition towards autoimmunity that we have no control over (e.g., the HLA-B27 gene for ankylosing spondylitis), there are numerous environmental triggers of these diseases that we can do something about. Identifying and correcting these factors stacks the odds in your favor of reducing autoimmune inflammation, swelling, pain, organ dysfunction, and can even reverse an autoimmune condition altogether.

Among the most important factors to correct in order to minimize or reverse autoimmunity are:


Wheat and grain elimination

If you are reading this, you likely already know that the gliadin protein of wheat and related proteins in other grains (especially the secalin of rye, the hordein of barley, zein of corn, perhaps the avenin of oats) initiate the intestinal “leakiness” that begins the autoimmune process, an effect that occurs in over 90% of people who consume wheat and grains. The flood of foreign peptides/proteins, bacterial lipopolysaccharide, and grain proteins themselves cause immune responses to be launched against these foreign factors. If, for instance, an autoimmune response is triggered against wheat gliadin, the same antibodies can be aimed at the synapsin protein of the central nervous system/brain, resulting in dementia or cerebellar ataxia (destruction of the cerebellum resulting in incoordination and loss of bladder and bowel control). Wheat and grain elimination is by far the most important item on this list to reverse autoimmunity.

Correct vitamin D deficiency

It is clear that, across a spectrum of autoimmune diseases, vitamin D deficiency serves a permissive, not necessarily causative, role in allowing an autoimmune process to proceed. It is clear, for instance, that autoimmune conditions such as type 1 diabetes in children, rheumatoid arthritis, and Hashimoto’s thyroiditis are more common in those with low vitamin D status, much less common in those with higher vitamin D levels. For this and other reasons, I aim to achieve a blood level of 25-hydroxy vitamin D level of 60-70 ng/ml, a level that usually requires around 4000-8000 units per day of D3 (cholecalciferol) in gelcap or liquid form (never tablet due to poor or erratic absorption). In view of the serious nature of autoimmune diseases, it is well worth tracking occasional blood levels.

Supplement omega-3 fatty acids

While omega-3 fatty acids, EPA and DHA, from fish oil have proven only modestly helpful by themselves, when cast onto the background of wheat/grain elimination and vitamin D, omega-3 fatty acids compound anti-inflammatory benefits, such as those exerted via cyclooxygenase-2. This requires a daily EPA + DHA dose of around 3600 mg per day, divided in two. Don’t confuse EPA and DHA omega-3s with linolenic acid, another form of omega-3 obtained from meats, flaxseed, chia, and walnuts that does not not yield the same benefits. Nor can you use krill oil with its relatively trivial content of omega-3s.

Eliminate dairy

This is true in North America and most of Western Europe, less true in New Zealand and Australia. Autoimmunity can be triggered by the casein beta A1 form of casein widely expressed in dairy products, but not by casein beta A2 and other forms. Because it is so prevalent in North America and Western Europe, the most confident way to avoid this immunogenic form of casein is to avoid dairy altogether. You might be able to consume cheese, given the fermentation process that alters proteins and sugar, but that has not been fully explored.

Cultivate healthy bowel flora

People with autoimmune conditions have massively screwed up bowel flora with reduced species diversity and dominance of unhealthy species. We restore a healthier anti-inflammatory panel of bacterial species by “seeding” the colon with high-potency probiotics, then nourishing them with prebiotic fibers/resistant starches, a collection of strategies summarized in the Cureality Digestive Health discussions. People sometimes view bowel flora management as optional, just “fluff”–it is anything but. Properly managing bowel flora can be a make-it-or-break-it advantage; don’t neglect it.

There you go: a basic list to get started on if your interest is to begin a process of unraveling the processes of autoimmunity. In some conditions, such as rheumatoid arthritis and polymyalgia rheumatica, full recovery is possible. In other conditions, such as Hashimoto’s thyroiditis and the pancreatic beta cell destruction leading to type 1 diabetes, reversing the autoimmune inflammation does not restore organ function: hypothyroidism results after thyroiditis quiets down and type 1 diabetes and need for insulin persists after pancreatic beta cell damage. But note that the most powerful risk factor for an autoimmune disease is another autoimmune disease–this is why so many people have more than one autoimmune condition. People with Hashimoto’s, for instance, can develop rheumatoid arthritis or psoriasis. So the above menu is still worth following even if you cannot hope for full organ recovery

Five Powerful Ways to Reduce Blood Sugar

Left to conventional advice on diet and you will, more than likely, succumb to type 2 diabetes sooner or later. Follow your doctor’s advice to cut fat and eat more “healthy whole grains” and oral diabetes medication and insulin are almost certainly in your future. Despite this, had this scenario played out, you would be accused of laziness and gluttony, a weak specimen of human being who just gave into excess.

If you turn elsewhere for advice, however, and ignore the awful advice from “official” sources with cozy relationships with Big Pharma, you can reduce blood sugars sufficient to never become diabetic or to reverse an established diagnosis, and you can create a powerful collection of strategies that handily trump the worthless advice being passed off by the USDA, American Diabetes Association, the American Heart Association, or the Academy of Nutrition and Dietetics.

Among the most powerful and effective strategies to reduce blood sugar:

1) Eat no wheat nor grains

Recall that amylopectin A, the complex carbohydrate of grains, is highly digestible, unlike most of the other components of the seeds of grasses AKA “grains,” subject to digestion by the enzyme, amylase, in saliva and stomach. This explains why, ounce for ounce, grains raise blood sugar higher than table sugar. Eat no grains = remove the exceptional glycemic potential of amylopectin A.

2) Add no sugars, avoid high-fructose corn syrup

This should be pretty obvious, but note that the majority of processed foods contain sweeteners such as sucrose or high-fructose corn syrup, tailored to please the increased desire for sweetness among grain-consuming people. While fructose does not raise blood sugar acutely, it does so in delayed fashion, along with triggering other metabolic distortions such as increased triglycerides and fatty liver.

3) Vitamin D

Because vitamin D restores the body’s normal responsiveness to insulin, getting vitamin D right helps reduce blood sugar naturally while providing a range of other health benefits.

4) Restore bowel flora

As cultivation of several Lactobacillus and Bifidobacteria species in bowel flora yields fatty acids that restore insulin responsiveness, this leads to reductions in blood sugar over time. Minus the bowel flora-disrupting effects of grains and sugars, a purposeful program of bowel flora restoration is required (discussed at length in the Cureality Digestive Health section.)

5) Exercise

Blood sugar is reduced during and immediately following exercise, with the effect continuing for many hours afterwards, even into the next day.

Note that, aside from exercise, none of these powerful strategies are advocated by the American Diabetes Association or any other “official” agency purporting to provide dietary advice. As is happening more and more often as the tide of health information rises and is accessible to all, the best advice on health does not come from such agencies nor from your doctor but from your efforts to better understand the truths in health. This is our core mission in Cureality. A nice side benefit: information from Cureality is not accompanied by advertisements from Merck, Pfizer, Kelloggs, Kraft, or Cadbury Schweppes.

Cureality App Review: Breathe Sync



Biofeedback is a wonderful, natural way to gain control over multiple physiological phenomena, a means of tapping into your body’s internal resources. You can, for instance, use biofeedback to reduce anxiety, heart rate, and blood pressure, and achieve a sense of well-being that does not involve drugs, side-effects, or even much cost.

Biofeedback simply means that you are tracking some observable physiologic phenomenon—heart rate, skin temperature, blood pressure—and trying to consciously access control over it. One very successful method is that of bringing the beat-to-beat variation in heart rate into synchrony with the respiratory cycle. In day-to-day life, the heart beat is usually completely out of sync with respiration. Bring it into synchrony and interesting things happen: you experience a feeling of peace and calm, while many healthy phenomena develop.

A company called HeartMath has applied this principle through their personal computer-driven device that plugs into the USB port of your computer and monitors your heart rate with a device clipped on your earlobe. You then regulate breathing and follow the instructions provided and feedback is obtained on whether you are achieving synchrony, or what they call “coherence.” As the user becomes more effective in achieving coherence over time, positive physiological and emotional effects develop. HeartMath has been shown, for instance, to reduce systolic and diastolic blood pressure, morning cortisol levels (a stress hormone), and helps people deal with chronic pain. Downside of the HeartMath process: a $249 price tag for the earlobe-USB device.

But this is the age of emerging smartphone apps, including those applied to health. Smartphone apps are perfect for health monitoring. They are especially changing how we engage in biofeedback. An app called Breathe Sync is available that tracks heart rate using the camera’s flash on the phone. By tracking heart rate and providing visual instruction on breathing pattern, the program generates a Wellness Quotient, WQ, similar to HeartMath’s coherence scoring system. Difference: Breathe Sync is portable and a heck of a lot less costly. I paid $9.99, more than I’ve paid for any other mainstream smartphone application, but a bargain compared to the HeartMath device cost.

One glitch is that you need to not be running any other programs in the background, such as your GPS, else you will have pauses in the Breathe Sync program, negating the value of your WQ. Beyond this, the app functions reliably and can help you achieve the health goals of biofeedback with so much less hassle and greater effectiveness than the older methods.

If you are looking for a biofeedback system that provides advantage in gaining control over metabolic health, while also providing a wonderful method of relaxation, Breathe Sync, I believe, is the go-to app right now.

Amber’s Top 35 Health and Fitness Tips

This year I joined the 35 club!  And in honor of being fabulous and 35, I want to share 35 health and fitness tips with you! 

1.  Foam rolling is for everyone and should be done daily. 
2.  Cold showers are the best way to wake up and burn more body fat. 
3.  Stop locking your knees.  This will lead to lower back pain. 
4.  Avoid eating gluten at all costs. 
5.  Breath deep so that you can feel the sides or your lower back expand. 
6.  Swing a kettlebell for a stronger and great looking backside. 
7.  Fat is where it’s at!  Enjoy butter, ghee, coconut oil, palm oil, duck fat and many other fabulous saturated fats. 
8.  Don’t let your grip strength fade with age.  Farmer carries, kettlebells and hanging from a bar will help with that. 
9.  Runners, keep your long runs slow and easy and keep your interval runs hard.  Don’t fall in the chronic cardio range. 
10.  Drink high quality spring or reverse osmosis water. 
11.  Use high quality sea salt season food and as a mineral supplement. 
12.  Work your squat so that your butt can get down to the ground.  Can you sit in this position? How long?
13.  Lift heavy weights!  We were made for manual work,.   Simulate heavy labor in the weight room. 
14.  Meditate daily.  If you don’t go within, you will go with out.  We need quiet restorative time to balance the stress in our life. 
15.  Stand up and move for 10 minutes for every hour your sit at your computer. 
16. Eat a variety of whole, real foods. 
17.  Sleep 7 to 9 hours every night. 
18.  Pull ups are my favorite exercise.  Get a home pull up bar to practice. 
19.  Get out and spend a few minutes in nature.  Appreciate the world around you while taking in fresh air and natural beauty. 
20.  We all need to pull more in our workouts.  Add more pulling movements horizontally and vertically. 
21. Surround yourself with health minded people. 
22. Keep your room dark for deep sound sleep.  A sleep mask is great for that! 
23. Use chemical free cosmetics.  Your skin is the largest organ of your body and all chemicals will absorb into your blood stream. 
24. Unilateral movements will help improve symmetrical strength. 
25. Become more playful.  We take life too seriously, becoming stress and overwhelmed.  How can you play, smile and laugh more often?
26.  Choose foods that have one ingredient.  Keep your diet simple and clean. 
27.  Keep your joints mobile as you age.  Do exercises that take joints through a full range of motion. 
28. Go to sleep no later than 10:30pm.  This allows your body and brain to repair through the night. 
29. Take care of your health and needs before others.  This allows you to be the best spouse, parent, coworker, and person on the planet. 
30.  Always start your daily with a high fat, high protein meal.  This will encourage less sugar cravings later in the day. 
31. Approach the day with positive thinking!  Stinkin’ thinkin’ only leads to more stress and frustration. 
32. You are never “too old” to do something.  Stay young at heart and keep fitness a priority as the years go by. 
33. Dream big and go for it. 
34.  Lift weights 2 to 4 times every week.  Strong is the new sexy. 
35.  Love.  Love yourself unconditionally.  Love your life and live it to the fullest.  Love others compassionately. 

Amber B.
Cureality Exercise and Fitness Coach

To Change, You Need to Get Uncomfortable

Sitting on the couch is comfortable.  Going through the drive thru to pick up dinner is comfortable.  But when you notice that you’re out-of-shape, tired, sick and your clothes no longer fit, you realize that what makes you comfortable is not in align with what would make you happy.   

You want to see something different when you look in the mirror.  You want to fit into a certain size of jeans or just experience your day with more energy and excitement.  The current condition of your life causes you pain, be it physical, mental or emotional.  To escape the pain you are feeling, you know that you need to make changes to your habits that keep you stuck in your current state.  But why is it so hard to make the changes you know that will help you achieve what you want?  

I want to lose weight but….

I want a six pack but…

I want more energy but….

The statement that follows the “but” is often a situation or habit you are comfortable with.  You want to lose weight but don’t have time to cook healthy meals.  So it’s much more comfortable to go through the drive thru instead of trying some new recipes.   New habits often require a learning curve and a bit of extra time in the beginning.  It also takes courage and energy to establish new routines or seek out help.  

Setting out to achieve your goals requires change.  Making changes to establish new habits that support your goals and dreams can be uncomfortable.  Life, as you know it, will be different.  Knowing that fact can be scary, but so can staying in your current condition.  So I’m asking you to take a risk and get uncomfortable so that you can achieve your goals.  

Realize that it takes 21 days to develop a new habit.  I believe it takes triple that amount of time to really make a new habit stick for the long haul.  So for 21 days, you’ll experience some discomfort while you make changes to your old routine and habits.  Depending on what you are changing, discomfort could mean feeling tired, moody, or even withdrawal symptoms.  However, the longer you stick to your new habits the less uncomfortable you start to feel.  The first week is always the worst, but then it gets easier.

Making it through the uncomfortable times requires staying focused on your goals and not caving to your immediate feelings or desires.  I encourage clients to focus on why their goals important to them.  This reason or burning desire to change will help when old habits, cravings, or situations call you back to your old ways.
Use a tracking and a reward system to stay on track.  Grab a calendar, journal or index card to check off or note your daily successes.  Shoot for consistency and not perfection when trying to make changes.  I encourage my clients to use the 90/10 principle of change and apply that to their goal tracking system.  New clothes, a massage, or a day me-retreat are just a few examples of rewards you can use to sticking to your tracking system.  Pick something that really gets you excited.  

Getting support system in place can help you feel more comfortable with being uncomfortable.  Hiring a coach, joining an online support group, or recruiting family and friends can be very helpful when making big changes.  With a support system in place you are not alone in your discomfort.  You’re network is there for you to reach out for help, knowledge, accountability or camaraderie when you feel frustrated and isolated.  

I’ve helped hundreds of people change their bodies, health and lives of the eleven years I’ve worked as a trainer and coach.  I know it’s hard, but I also know that if they can do it, so can you.  You just need to step outside of your comfort zone and take a risk. Don’t let fear create uncomfortable feelings that keep you stuck in your old ways.  Take that first step and enjoy the journey of reaching your goals and dreams.  

Amber Budahn, B.S., CSCS, ACE PT, USATF 1, CHEK HLC 1, REIKI 1
Cureality Exercise Specialist

The 3 Best Grain Free Food Swaps to Boost Fat Burning

You can join others enjoying substantial improvements in their health, energy and pant size by making a few key, delicious substitutions to your eating habits.  This is possible with the Cureality nutrition approach, which rejects the idea that grains should form the cornerstone of the human diet.  

Grain products, which are seeds of grasses, are incompatible with human digestion.  Contrary to what we have been told for years, eating healthy whole grain is not the answer to whittle away our waists.  Consumption of all grain-based carbohydrates results in increased production of the fat storage hormone insulin.  Increased insulin levels create the perfect recipe for weight gain. By swapping out high carbohydrate grain foods that cause spikes in insulin with much lower carbohydrate foods, insulin release is subdued and allows the body to release fat.

1. Swap wheat-based flour with almond flour/meal

  • One of the most dubious grain offenders is modern wheat. Replace wheat flour with naturally wheat-free, lower carbohydrate almond flour.  
  • Almond flour contains a mere 12 net carbs per cup (carbohydrate minus the fiber) with 50% more filling protein than all-purpose flour.
  • Almond flour and almond meal also offer vitamin E, an important antioxidant to support immune function.

2. Swap potatoes and rice for cauliflower

  • Replace high carb potatoes and pasta with vitamin C packed cauliflower, which has an inconsequential 3 carbs per cup.  
  • Try this food swap: blend raw cauliflower in food processor to make “rice”. (A hand held grater can also be used).  Sautee the “riced” cauliflower in olive or coconut oil for 5 minutes with seasoning to taste.
  • Another food swap: enjoy mashed cauliflower in place of potatoes.  Cook cauliflower. Place in food processor with ½ a stick organic, grass-fed butter, ½ a package full-fat cream cheese and blend until smooth. Add optional minced garlic, chives or other herbs such as rosemary.
3. Swap pasta for shirataki noodles and zucchini

  • Swap out carb-rich white pasta containing 43 carbs per cup with Shirataki noodles that contain a few carbs per package. Shirataki noodles are made from konjac or yam root and are found in refrigerated section of supermarkets.
  • Another swap: zucchini contains about 4 carbs per cup. Make your own grain free, low-carb noodles from zucchini using a julienne peeler, mandolin or one of the various noodle tools on the market.  

Lisa Grudzielanek, MS,RDN,CD,CDE
Cureality Nutrition Specialist

Not so fast. Don’t make this mistake when going gluten free!

Beginning last month, the Food and Drug Administration began implementing its definition of “gluten-free” on packaged food labels.  The FDA determined that packaged food labeled gluten free (or similar claims such as "free of gluten") cannot contain more than 20 parts per million of gluten.

It has been years in the making for the FDA to define what “gluten free” means and hold food manufactures accountable, with respect to food labeling.  However, the story does not end there.

Yes, finding gluten-free food, that is now properly labeled, has become easier. So much so the market for gluten-free foods tops $6 billion last year.   However, finding truly healthy, commercially prepared, grain-free foods is still challenging.

A very common mistake made when jumping into the gluten-free lifestyle is piling everything labeled gluten-free in the shopping cart.  We don’t want to replace a problem: wheat, with another problem: gluten free products.

Typically gluten free products are made with rice flour (and brown rice flour), tapioca starch, cornstarch, and potato flour.  Of the few foods that raise blood sugar higher than wheat, these dried, powdered starches top the list.

 They provide a large surface area for digestion, thereby leading to sky-high blood sugar and all the consequences such as diabetes, hypertension, cataracts, arthritis, and heart disease. These products should be consumed very rarely consumed, if at all.  As Dr. Davis has stated, “100% gluten-free usually means 100% awful!”

There is an ugly side to the gluten-free boom taking place.  The Cureality approach to wellness recommends selecting gluten-free products wisely.  Do not making this misguided mistake and instead aim for elimination of ALL grains, as all seeds of grasses are related to wheat and therefore overlap in many effects.

Lisa Grudzielanek MS, RDN, CD, CDE
Cureality Health & Nutrition Coach

3 Foods to Add to Your Next Grocery List

Looking for some new foods to add to your diet? Look no further. Reach for these three mealtime superstars to encourage a leaner, healthier body.

Microgreens

Microgreens are simply the shoots of salad greens and herbs that are harvested just after the first leaves have developed, or in about 2 weeks.  Microgreen are not sprouts. Sprouts are germinated, in other words, sprouted seeds produced entirely in water. Microgreens are grown in soil, thereby absorbing the nutrients from the soil.

The nutritional profile of each microgreen depends greatly on the type of microgreen you are eating. Researchers found red cabbage microgreens had 40 times more vitamin E and six times more vitamin C than mature red cabbage. Cilantro microgreens had three times more beta-carotene than mature cilantro.

A few popular varieties of microgreens are arugula, kale, radish, pea, and watercress. Flavor can vary from mild to a more intense or spicy mix depending on the microgreens.  They can be added to salads, soup, omelets, stir fry and in place of lettuce.  

Cacao Powder

Cocoa and cacao are close enough in flavor not to make any difference. However, raw cacao powder has 3.6 times the antioxidant activity of roasted cocoa powder.  In short, raw cacao powder is definitely the healthiest, most beneficial of the powders, followed by 100% unsweetened cocoa.

Cacao has more antioxidant flavonoids than blueberries, red wine and black and green teas.  Cacao is one of the highest sources of magnesium, a great source of iron and vitamin C, as well as a good source of fiber for healthy bowel function.
Add cacao powder to milk for chocolate milk or real hot chocolate.  Consider adding to coffee for a little mocha magic or sprinkle on berries and yogurt.




Shallots


Shallots have a better nutrition profile than onions. On a weight per weight basis, they have more anti-oxidants, minerals, and vitamins than onions. Shallots have a milder, less pungent taste than onions, so people who do not care for onions may enjoy shallots.

Like onions, sulfur compounds in shallot are necessary for liver detoxification pathways.  The sulfur compound, allicin has been shown to be beneficial in reducing cholesterol.  Allicin is also noted to have anti-bacterial, anti-viral, and anti-fungal activities.

Diced then up and add to salads, on top of a bun less hamburger, soups, stews, or sauces.  Toss in an omelet or sauté to enhance a piece of chicken or steak, really the possibilities are endless.  

Lisa Grudzielanek,MS,RDN,CD,CDE
Cureality Nutrition & Health Coach

3 Band Exercises for Great Glutes

Bands and buns are a great combination.  (When I talk about glutes or a butt, I use the word buns)  When it comes to sculpting better buns, grab a band.   Bands are great for home workouts, at gym or when you travel.  Check out these 3 amazing exercises that will have your buns burning. 

Band Step Out

Grab a band and place it under the arch of each foot.  Then cross the band and rest your hands in your hip sockets.  The exercise starts with your feet hip width apart and weight in the heels.  Slightly bend the knees and step your right foot out to the side.  Step back in so that your foot is back in the starting position.  With each step, make sure your toes point straight ahead.  The tighter you pull the band, the more resistance you will have.    You will feel this exercise on the outside of your hips. 

Start with one set of 15 repetitions with each foot.  Work on increasing to 25 repetitions on each side and doing two to three sets.



Band Kick Back

This exercise is performed in the quadruped position with your knees under hips and hands under your shoulders.    Take the loop end of the band and put it around your right foot and place the two handles or ends of the band under your hands.  Without moving your body, kick your right leg straight back.  Return to the starting quadruped position.  Adjust the tension of the band to increase or decrease the difficulty of this exercise. 

Start with one set of 10 repetitions with each foot.  Work on increasing to 20 repetitions on each side and doing two to three sets. 



Band Resisted Hip Bridge

Start lying on your back with feet hip distance apart and knees bent at about a 45-degree angle.  Adjust your hips to a neutral position to alleviate any arching in your lower back.  Place the band across your hipbones.  Hold the band down with hands along the sides of your body.  Contract your abs and squeeze your glutes to lift your hips up off the ground.  Stop when your thighs, hips and stomach are in a straight line.  Lower you hips back down to the ground. 

Start with one set of 15 repetitions.  Work on increasing to 25 repetitions and doing two to three.  Another variation of this exercise is to hold the hip bridge position.  Start with a 30 second hold and work up to holding for 60 seconds.

Magnesium and arrhythmia

Magnesium and arrhythmia

Because magnesium is removed during municipal water treatment and is absent from most bottled water, deficiency of this crucial mineral is a growing problem.

Magnesium deficiency can manifest itself in a wide variety of ways, from muscle cramps (usually calves, toes, and fingers), erratic blood sugars, higher blood pressure, to heart rhythm problems. The abnormal heart rhythms that can arise due to magnesium deficiency include premature atrial contractions, premature ventricular contractions, multifocal atrial tachycardia, atrial fibrillation, and even ventricular tachycardia, fibrillation, and Torsade de Pointes (all potentially fatal). Magnesium is important!

Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

Here is a Heart Scan Blog reader's dramatic rhythm-correcting response to magnesium supplementation:



Dr. Davis,

A few months ago, I contacted you inquiring if you had written any articles on arrhythmia. You were generous enough to answer and guide me to an LEF article you'd written in which you stressed fish oil and magnesium. I had been suffering with bad PVCs [premature ventricular contractions] for over 20 years, and they had gotten so bad recently that I was told my next options were ablation or pacemaker!

I was already on fish oil and had not seen any difference, and so I researched the magnesium you suggested more thoroughly and found a huge body of studies supportng its effect on arrhythmia. I also read many posts on heart forums with people having success with it. After getting advice from various bloggers, I tried magnesium taurate in the morning and Natural Calm (an ionized form of mag citrate) in the afternoon and evening. Within three days the PVCs were quite diminished and by 2 weeks totally gone! As long as I keep taking it, they never return---not even one irregular blip---even when I drink strong coffee! The magnesium also cleared up my restless leg syndrome, my eye twitching, and insomnia. (Apparently, I was the poster-girl for magnesium deficiency.)

I am so angry that after all these years of suffering, trying various medications, and seeing at least 4 different cardiologists that NOT ONE ever even mentioned trying magnesium. The generosity of the few minutes you took to answer my email and steer me in a helpful direction brought me total relief.

Thank you SO MUCH!

Warmly,
Catherine C.

Comments (35) -

  • Emily

    2/11/2010 4:17:58 PM |

    are there not food sources of magnesium that are bio-available as well as the option of supplementing?

  • Mike

    2/11/2010 4:33:25 PM |

    I'll echo my thoughts on magnesium's anti-arrythmic properties; in my early 20's, I found I had intermittent episodes of frequent multi-focal PVC (premature ventricular contractions), exacerbated by stress and caffeine.  I saw a cardiologist for this, and had no subsequent treatment or follow up.

    In my 30's, I started supplementing with ZMA (zinc, magnesium and B6) to improve athletic recovery; I  noticed a nice, regular sinus rhythm on the cardiac monitor (I work as a firefighter/paramedic).  

    I have no doubt that a vast majority of people, especially athletes, are deficient in magnesium.  One of thee most important minerals!  Even with a solid diet, Mg is hard to come by, and excretion is enhanced through physical activity and sweating.  I like ZMA personally, but I have heard good things about Natural Calm.

  • davide

    2/11/2010 5:48:23 PM |

    ...three other very common results of magnesium deficiencies:

    1. Constipation
    2. Headaches
    3. Muscle tension/cramps


    I say this from first hand experience. I will not go a day without it. But it is important to use the right kind of magnesium. Magnesium oxide is the least preferred.

  • TedHutchinson

    2/11/2010 6:02:55 PM |

    68% of USA adults don't reach the current RDA intake for magnesium and most people who understand the issue would say, like the RDA for Vitamin D, the current magnesium RDA is woefully inadequate.
    KRISPIN has a useful  
    Formula to Calculate Magnesium Daily Requirement-  5 to 10 milligrams per day per kilo of ideal body weight or 2.5 to 4.5 milligrams per day per pound of ideal body weight.  

    Example: 70 kilos or 150 pounds= 350 mg. to 700 mg. daily.  

    Magnesium is an incredibly safe mineral to supplement with and too much magnesium passes into the colon where it's hygroscopic properties means it attracts water and the result is loose stools. So you will be made aware when you have taken too much magnesium.
    Fellow misers may want to consider DEAD SEA SALTS magnesium chloride available in 25kg sacks from Equine  suppliers, Country Traders, suppliers to small farmers and livestock merchants. In the UK its pretty cheap £7ish a bag. Epsom Salts works as well if not better if you have arthritis. (Think Health Spa) but may be twice the price.Here's how to use it The advantage of having a soak in  magnesium rich bath water is your body won't absorb more than it needs transdermally.
    Do take note of the fact that magnesium calms nerves and relaxes muscle fibers.
    Soaking in a hot bath enriched with magnesium chloride (Dead Sea salts or magnesium sulphate (Epsom Salts) will leave you ready for bed and a good nights sleep. So later in the day, rather than morning.
    Lots of good magnesium info here MGWATER

    Don't try telling anyone on Diabetes forums of the relationship of magnesium to diabetes it's almost as provocative as trying to explain the Vitamin D Diabetes interrelation and will surely see you banned.

  • Anonymous

    2/11/2010 6:24:34 PM |

    The onset of PVC's in my mid-40's occurred about the same time as the onset of blindlingly painful nocturnal leg cramps of the calves and thighs.

    God only knows how many tests were ordered by the cardiologist I saw, or the other doctors that followed.  A lot of tests, not much to show for it except the threat of a statin prescription, a prescription for a "heart healthy" diet, a la the American Heart Association, and a pat on the head or two.

    Relief came several years later in the form of daily supplementation with magnesium glycinate ordered by a physician, whose practice is devoted to wellness... not sickness.

    madcook

  • DancinPete

    2/11/2010 8:46:11 PM |

    Is there an easy/cheap way to find out if you're magnesium deficient without getting a blood test?

  • TedHutchinson

    2/11/2010 11:25:51 PM |

    @ DancinPete
    Is there an easy/cheap way to find out if you're magnesium deficient without getting a blood test?

    Magnesium supplementation is so cheap and safe it's probably worth assuming you are deficient, take an effective amount, and if or when you start to get loose stools, back down a bit so you don't have that problem.

    Least well absorbed form is magnesium oxide.

    I use magnesium malate but magnesium citrate is fine for those who need the laxative properties.

  • Anonymous

    2/11/2010 11:40:11 PM |

    On a  very low-carb diet with little vegetables and no fruit, is it important to supplement potassium as well as magnesium?  If so, how much potassium?

  • polyhex

    2/12/2010 12:10:33 AM |

    I have seen the same thing in myself.  

    I had leg cramps in pregnancy which I stopped cold with magnesium.  An unanticipated side effect was the total resolution of a minor but persistent arrhythmia.  Recently I was lax in taking the supplements and my arrhythmia came back, exacerbated by exhaustion (new baby) and caffeine (new baby.)  I started the magnesium again and it's gone!

  • Chloe

    2/12/2010 12:57:06 AM |

    On magnesium and calcium from my experience:  I increased my D3 supplementation (boosted 7 reading to 98, GrassRoots Health testing), but started to experience very high "fluttery" pulse, 140+ and I am in my 60s.  OMG how bad I felt.  Practically everywhere I searched said up the magnesium.  I did (magnesium taurate) but this problem continued.  I then changed on the following page and it has saved me:  
    http://www.ithyroid.com/ca_and_mg.htm

    Calcium citrate powder in water with a little bit of vitamin C powder (read calcium better absorbed in acidic environment) would bring my pulse and blood pressure down within 30 minutes.  

    Since I am without health insurance or the means to see a doctor anyway, I can only deal with the symptoms and not know the official diagnosis.

    My pulse was high, weak, and "fluttery."  Now that I supplement with 2000 mg of calcium citrate and 1000 mg of magnesium taurate my heart problems have disappeared.

  • Mike

    2/12/2010 3:27:33 AM |

    Nice posts, Ted.  And excellent blog!

  • Anonymous

    2/12/2010 4:44:22 AM |

    I take Natures Calm at night (makes me sleep like a baby) and pop a few mg citrates during the day.  If I take Natures Calm during the day I get way too relaxed.

    Heart palpitations and leg cramps seems to go hand in hand with me. Extra mg knocks out both.

    However, one time I ran out of my citrate tabs and grabbed a container of a mag/cal supplement.   That combination did nothing for me, no matter how much I took.  The ratio of calcium to mg was way off favoring calcium.  Also, I notice if I take in too much yogurt and cheese the effects of my mg seems to wane.

    My only theory is that its true that if your calcium intake exceeds your mg intake by too much it can block the benefits. So far that has been my experience. Not a psychosomatic response, since I knew nothing of it until I looked it up after the cal/mg  blend didn't help me. Wow.

  • Barkeater

    2/12/2010 7:09:40 PM |

    I looked into blood tests, but concluded that that was not a very practical or accurate way to assess magnesium deficiency.  

    I concur with those that say if you have symptoms that might be magnesium deficiency, go ahead and supplement because your probably are deficient and there is no harm in it.  I had a lifetime pattern of getting severe leg cramps any time I exercised hard (like playing soccer) for more than say 80 minutes.  That was a very good hint.

    But, I was not content to leave it at that.  I looked at my diet, the reported mg content of food in it, and the RDA for me of 420mg of magnesium per day.  It was totally obvious that, even with my pretty healthy diet, I must be below 300mg of mg per day.  IT IS SO EASY TO GUESTIMATE YOUR NUTRIENT INTAKE THIS WAY, but nobody seems to suggest it.  Instead you see mindless blather about eating a few other foods that are high in mg -- go ahead and do the math and you will see that you need to be really dedicated to make that work.

    This kind of a self-assessment of the nutrient content of your normal diet, in many cases, will show that you don't take in recommended levels of iodine, potassium, and selenium, either.  Like mg, these are involved in countless ways in our biology.  Potassium is the one of these that is trickier to supplement - that you probably need to correct by shifting salt use to mixed salts (or no-salt) that have potassium chloride.  It turns out that my cramping issue needs both mg and potassium to be kept at bay, but together they work.  (Getting salt-potassium in better balance is good for blood pressure, too.  My systolic and diastolic dropped 10 points each since joining TYP a year ago.)

    I supplement mg with mag water, per the TYP web site.  Cheap and absorbable, no side effects, easy to incorporate into your regimen, and nice not to take one more pill.

  • Dr. William Davis

    2/12/2010 7:41:41 PM |

    The only way to truly know your magnesium status, short of waiting for clear-cut evidence of deficiency (muscle cramps, heart rhythm disorders, etc) is to check a blood level, preferably an RBC level, not a serum level. The RBC level is a rough approximation of tissue levels.

  • DrStrange

    2/14/2010 6:49:56 PM |

    If you hunt around you can also get magnesium ascorbate which gives a nice two-fer.  I get mine from Intensive Nutrition, one tablet contains 100mg magnesium and 1000 mg vit C as ascorbate.  Also, NOW brand makes a powdered one and Source Naturals also...

  • Anonymous

    2/16/2010 7:23:15 AM |

    Magnesium is one of the essential components necessary for the body to function normally. It is not just necessary for human; rather, it is essential for all living organisms as magnesium ions are a part of the nucleic acid chemistry of all living cells and things. Because it is so vital, you can imagine what should happen if someone were to be magnesium deficient. It is not a pretty picture, indeed.

    More Info: Sign and Symptoms of Magnesium

  • chris

    2/16/2010 4:56:50 PM |

    Theres no need to supplement if you are eating several servings of legumes and nuts every day.

    I have replaced most grain use in recipes with legumes, and nuts are a good food on the go.

  • Mike

    2/16/2010 11:55:59 PM |

    "Several serving s of legumes and nuts" will effectively increase your intake of inflammatory lectins and omega-6s.

    I'll stick to supplementing.

  • Anonymous

    2/24/2010 11:47:52 PM |

    My leg cramps were also resolved by magnesium supplementation. Many people don't realize that eating grains will severely inhibit the absorption of minerals, due to their phytate content (an "anti-nutrient") and will therefore contribute to magnesium and other mineral deficiencies. The phytates in grains can be mostly eliminated by soaking and/or sprouting them before consumption.

  • L. Cramp

    3/16/2010 7:52:39 PM |

    I have always been fascinated by the question ,why some people can and others cant. I spent years trying to figure this out. At first it was mainly for myself. I remember growing up with little confidence and under the impression that others were more capable than I was. The fact was that this impression was true. It was true because i believed it.

  • Helena

    4/15/2010 6:54:29 PM |

    Hi Dr Davis,

    I just had my first experience, at least I think so, of arrhythmia on Tuesday night... My heart was beating really, really fast for about a minute or two and then it all just stopped and went back to normal.

    I try to take 150 mg of magnesium every day (on Tuesday I forgot to take all my supplements). What is your recommendation on how much I should take each day? Does it matter what kind, should I spread it out over the day or is once a day dose ok?

    The whole experience was a bit overwhelming for me and I want to make sure it does not happen again! If it however does, should I go to a doctor? What can I requests as far as 'safe' tests?

    My experiences with tests are usually pretty bad as I always end up in the 'normal' range... whatever that means. And I get the "You are just a crazy hypochondriac, go home" look from the doctors.

    Appreciate your comment on this. Thank you.

  • TedHutchinson

    4/16/2010 9:25:42 AM |

    @ Helena
    150mg magnesium daily probably isn't sufficient.
    Krispin's formula suggests someone 70 kilos = 150 pounds should have a  total intake between 350mg to 700mg daily.
    The current magnesium RDA of 420mg/men, 320mg/(non-pregnant) women but average US female intake is just 228mg/daily.

    You also do not state the form of magnesium supplement you take.
    Many of the magnesium blends available include magnesium oxide. It's likely, where percentages are not stated, this cheapest (least effective) form constitutes the bulk present. Only 4% of magnesium oxide is absorbed.

    Magnesium is best absorbed (like calcium) from small amounts, through the day, with meals. I find it easier to take magnesium with each meal of the day and before bed.

    Does a higher ratio of serum calcium to magnesium increase the risk for postmenopausal breast cancer?
    This paper hypothesizes that low levels of magnesium  increase calcium retention, higher calcium levels further depress magnesium absorption and the resulting cellular imbalance leads to cancer initiation. Magnesium intake is an extremely important aspect of Vitamin D supplementation that is often overlooked.

  • Dave, RN

    5/14/2010 4:25:51 AM |

    TEedHutchison, I've been there with the diabetes forum. When I suggested a  paleo very low carb diet to a confused person who was just diagnosed, I was called a "dangerous extremest" by who I believe was the moderator. All of my suggestions about magnesium and D3 were poo-pood by him, and besides an extremest, I was brushed of as "one of those people who occasionally shows up here".

  • Helena

    5/27/2010 3:05:03 PM |

    Thank you Ted.
    I will look at what type of Mg I am taking... and also increase the dose. If not I will order the magnesium you suggested. I have not had an event since that one time but I have had some slight feelings of dizziness and fluctuations in pulse. This is all due to coming off of a birth control pill that was killing me I am sure, it just takes time getting to know your body once again after years on synthetic hormones. Thank you again.

  • Anonymous

    5/28/2010 3:54:24 PM |

    Just want to say what a great blog you got here!
    I've been around for quite a lot of time, but finally decided to show my appreciation of your work!

    Thumbs up, and keep it going!

    Cheers
    Christian, iwspo.net

  • Anonymous

    6/7/2010 2:49:32 AM |

    Dr. Davis, I stumbled across The Heart Scan Blog after months and months of being frustrated with a heart arrhythmia that appeared out of the blue after a period of high stress and anxiety attacks late last fall.  I was feeling a lot of "skipped heartbeats" and immediately went to a cardiologist who ordered a stress echo and 24 hr holter monitor.  He told me it was a benign premature heartbeat which I was relieved about but after months of getting 20-30 a day, it was all I could think about.  Reading your blog and the discussion regarding magnesium has given me hope.  A few weeks ago, due to ease, I  was eating large quantities of quinoa which is rich in magnesium and noticed that the skipped beats subsided a bit to 5x a day.  I didnt know if there was a link but I am hopeful that there is a link and willing to give magnesium a try.  I've already purchased the magnesium taurate - what do you recommend in dosage? Please note, I am always worried about taking any supplements....are there negative side effects. Could it make my heart arrhythmia worse?  Thanks so much!! I am desperate to get back to a life where the skipped beats are not on my mind 24/7.

  • Phyllis

    6/9/2010 5:37:37 PM |

    I have had an annoying arrythmia for a very long time. Its worse at times, better at times. I have seen a cardiologist. He did an ekg which said that I had had a heart attack. Echo was done and Doc said I had not had a heart attack, but have PAC's and a leaky tri-cuspid valve. He also did a 24 hour holter monitor. Basically he said there wasn't anything bad wrong, but he put me on sotalol to try and clear up the palpitations and rapid-ish heart rate. Also, my BP was in the 100's range for the lower number.
    I have not noticed much difference as far as the palpitations go, after over a year on the sotalol.
    I have however gotten my eating/health under control, with low carb, I have lost around 45 pounds and am within 10 pounds of my goal weight. My blood pressure is running around 117/75 most mornings, I feel like a new person, now if these annoying palpitations would just go away...
    To that end, after reading this post I have just recieved my bottle of magnesium taurate and plan on adding it to me list of supplements which includes 5000 units of vitamin D per day for about the last 6 months.
    My reason for posting this here is I hope to be posting soon that the palpitations have cleared up.
    LOVE this blog, its one of the very few that I have discovered and gone back and read many of the older posts.
    God Bless you, Doc, for taking the time to really help people!

  • Tiza

    8/30/2010 6:37:32 PM |

    Nice blog. Basically, I couldn't do without my magnesium malate. If it wasn't for the magnesium, I probably would not be able to walk, or at least not very good because of my back.

    I noticed that someone asked about having their magnesium tested. First, blood tests are really worthless for testing magnesium. I've never had mine tested, but there is a test that Dr. Dean talks about.  It's here at this link, and it's a non-evasive test:

    http://www.exatest.com/

  • blogblog

    10/31/2010 8:42:09 AM |

    The cheapest and simplest magnesium supplement is Epsom Salts (magnesium sulphate). It only costs about $1/year. It is also extremely safe and is widely used in medicine. About 1/10th of a teaspoon dissolved in 1L water will do the trick. It is also an extraordinarily effective laxative in higher doses.

  • buy jeans

    11/2/2010 8:41:18 PM |

    Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

  • Drew

    1/6/2011 7:04:43 PM |

    Magnesium truly is the body's "master mineral." Without it, so many other minerals cannot be properly used in the body.

    Most people have a hard time with taking oral magnesium supplements and don't get the results their body needs.

    I was fortunate enough to come across "Transdermal Magnesium" or better know to me now as "Magnesium Oil."

    Magnesium Oil is simply a magnesium rich mineral solution that has been sourced from some body of salt water.

    Since the minerals in sea water are constantly being subjected to sunlight, it in turn makes the minerals ionic (ready for the body to use).

    It is as simple as spraying the solution on your skin and the body absorbs it directly into the cell. No digesting needed!!

    There are some concerns to be aware of however. Where are they sourcing their raw materials from? Is it clean of pollution and heavy metals?

    I have researched about every brand out there and a lot of them can be misleading.

    My favorite, by far, is Magnesoothe! They can be found at https://magnesoothe.com/index.html They handle there product in the very best manor from start to finish. They have the most helpful customer service. And their source goes unsurpassed!

    Their source is the Dead Sea and there is no other body of salt water like it on the  face of the planet! You can read more on the Dead Sea here at https://magnesoothe.com/dead-sea-facts.htm

    If you want to know more on the purity of Magnesoothe, you can read that here at https://magnesoothe.com/purity-cleanliness-clarity-magnesoothe.htm

    I hope that my 2 cent will be helpful to someone.

    Best of Health!
    The Magnesium Man

  • Hal

    4/26/2011 8:51:32 PM |

    About 1 1/2 years ago I started having arrhythmia issues which were diagnosed as atrial fibrillation.  I had my atenolol increased and this did help some but I was still having (mostly short) episodes on an almost daily basis a month later.  Looking around the net I found a paper that talked about how using preoperative Mg for open heart surgery reduced the incidence of AFib after surgery.  So I decided to try Mg.

    I started taking it to tolerance (IE. increased dose until I had loose stools and then back off a little) and in about a week the AFib episodes had gone away.  Now I only have AFib episodes if I forget taking Mg for a few weeks and it goes away in a few days if I start taking Mg again.

    What I find most distressing about this is that none of my doctors even considered recommending giving Mg a try as far as I can tell.   Why wouldn't it be one of the first things they try if there is no other apparent cause (like high/low potassium, for example).  In those cases where I told the doctor that Mg had helped their reaction was mostly along the lines of Mg can't cause too many issues so go ahead and take it.  But nothing about how it should be considered for treating arrhythmia.

  • kend

    11/21/2011 2:57:24 AM |

    A few yrs. back, I read a very interesting article written by a cardiologist concerning his having successfully treated a patient with arrythmia  with an intravenous solution of magnesium.

  • Ray

    2/9/2012 8:30:57 PM |

    I have had arrythmia for a few years now, I have been to two different consultants and both say "it''s benign and won''t do any harm" I however could not stand the horrible fluttery feeling when it happened so they put me on 2.5mg  of bisopronol. I found this was making me dizzy and so after getting the all clear from my angiogram with the doctors ok stopped taking them. I had read about the successful results of taking mangnesium and so at the start of this new year started taking 1000 mg a day and started a diary of taking my blood pressure and heart rate three times a day (I have a good home blood pressure meter that shows up arrythmia as well)  So far it seems to have cleared the arrythmia apart from the odd reading.
    I forgot to mention that where I differ from everyone elses posts is that I have a very slow pulse, 40-45 sitting and only 65 when I fast walk to work but it will go up to 120 if I do a hard session on the treadmill.  I am 61 and did have a slow heart rate when I did long distance jogging up to the age of forty.
    I would be interested to hear from anyone else that has a slow pulse.

Loading
Don't be a dipstick

Don't be a dipstick

If I want to know how much oil is in my car's engine, I check the dipstick.

The dipstick provides a gauge of the amount of oil in my engine. If the dipstick registers "full" because there an oil mark at one inch, I understand that there's more than one inch of oil in my engine. The dipstick provides an indirect gauge of the amount of oil in my engine.

That's what cholesterol was meant to provide: A gauge, a "dipstick," for the kind of lipoproteins (lipid-carrying proteins) in the bloodstream.

Lipoproteins are a collection of particles that are larger than a single cholesterol molecule but much smaller than a red blood cell. Lipoproteins consist of many components: various proteins, phospholipids, lots of triglycerides, as well as cholesterol. In the 1960s, methods to characterize lipoproteins were not widely available, so the cholesterol in lipoproteins were used as a "dipstick" to assess low-density lipoproteins ("LDL cholesterol") and high-density lipoproteins ("HDL cholesterol"). (Actually, even "LDL cholesterol" was not measured, but was derived from "total cholesterol," the quantity of cholesterol in all lipoprotein fractions.)

Some other component of lipoproteins could have been measured instead of cholesterol, such as apoprotein B, apoprotein C, or others, all meant to act as the "dipstick" for various lipoproteins.

Relying on cholesterol to characterize lipoproteins provides a misleading picture. Imagine watching cars go by at high speed while standing on the side of the highway. You want to count how many people--not cars, but people--go by in a given amount of time. Because you cannot make out the detail of each and every car whizzing by, you count the number of cars and assume that each car carries two people. Whether it's rush hour, Sunday morning, late evening, rainy, sunny, or snowing, you make the same assumption: two people per car.

That's what cholesterol does: It is assuming that each and every lipoprotein particle (car) carries the same amount of cholesterol (people).

But that may, obviously, not be true. A bus goes by carrying 25 people. Plenty of cars may carry just the driver. People carpooling may be in cars carrying 3 or 4 people. Assuming just 2 people per car can send your estimates way off course.

That is precisely what happens when your doctor tries to use conventional cholesterol values (total cholesterol, LDL cholesterol) to gauge the lipoproteins in your bloodstream. Measuring cholesterol can also provide the false impression that cholesterol is the cause of heart disease, even though it was originally meant to simply serve as a "dipstick."

What we need to do is to characterize lipoproteins themselves. We can distinguish them by size, number, density, charge, and the type and form of proteins contained within. It provides greater insight into the composition of lipoproteins in the blood. It provides greater insight into the causes underlying coronary atherosclerotic plaque. It can also tell us what dietary changes trigger different particle patterns and how to correct them.

Until you have a full lipoprotein analysis, you can never know for certain 1) if you will have heart disease in your future, or 2) how your heart disease was caused.

Unfortunately, the vast majority of doctors are perfectly content to just count cars going by and assume two people per car, i.e., confine assessment of your heart disease risk using cholesterol . . . just as drug industry marketing has instructed them.

It's not your job to educate your doctor. If he or she refuses to provide access to lipoprotein testing to better determine your heart disease risk, then consider going out on your own. Many of our Track Your Plaque program followers have obtained lipoprotein testing on their own through Direct Labs.

Comments (32) -

  • Anonymous

    10/3/2010 3:58:23 PM |

    Nice analogy.

    Any idea where we can go for equivalent tests in the UK?

    Nina

  • Kurt

    10/3/2010 6:02:39 PM |

    Thanks for the 10% off at Swanson's (your ad)!

    I took the VAP test and my results were excellent. It was very reassuring.

  • Jonathan

    10/3/2010 10:55:51 PM |

    That dipstick showing a lot or a little oil also doesn't tell you about the sand that chewed up your cylinders.

  • Kathryn

    10/4/2010 1:09:03 AM |

    I've used Direct Labs & others to order my own tests directly.  It works very well.

    Currently i'm working with a doc who seems willing to work with me.  However the cholesterol panel he ordered recently did not include the part that actually measures LDL (as opposed to "calculate" it).  He is not opposed to running that test, but tells me he doesn't know if Medicare (my insurance) will cover it.

    What is the name of the test i would need to run that actually measures LDL?

  • skepticaldoc

    10/4/2010 1:29:11 AM |

    Great analogy!!!

  • Anonymous

    10/4/2010 3:33:01 PM |

    Very nice post, but interesting irony.  The doctor implies it is drug companies responsible for the lack of useful testing, and then someone from the UK wants to know where he/she can go for equivalent tests.  Surely not to your primary care physician!  Many Canadians will also want to know because govts are much tighter than insurance companies, since the latter must compete for business.  Lesson: govt health care monopolies spend less because they do less (e.g., testing) and do it slower.

  • Anonymous

    10/4/2010 4:15:09 PM |

    Long time reader, just wanted to post some info that comes within the industry:
    "The nmr is not an accurate test. I cannot tell you how many physicians have lost confidence in the results due to the high variance in particle number. One physician ordered 2 nmrs on the same patient by accident and the difference in LDL-p was over 800. Pathetic. Stick to apoB." Sorry that this complicates things.

  • CarbSane

    10/4/2010 9:21:17 PM |

    Unfortunately, some states (I think at this point only NY & Cali) do not allow patient initiated tests outside the "system".  

    With Obamacare, I fear more states will follow this, as gawd forbid anyone tries to get a handle on their own health markers, at their own expense and/or try to do anything (like changes in diet) to improve them.

  • Anonymous

    10/5/2010 3:14:15 AM |

    "With Obamacare, I fear more states will follow this, as gawd forbid anyone tries to get a handle on their own health markers, at their own expense and/or try to do anything (like changes in diet) to improve them."

    Please tell me what, specifically, in "Obamacare" would prohibit the sort of tests you're interested in?  I'm pretty sure you can't provide an answer.  Your claim (and fears) is not grounded in fact, but rests on the ideologically motivated obfuscations of others who have a vested interest in resisting meaningful healthcare reform.  I'm sure we all had it much better the day before "Obamacare" went into effect.

  • Anonymous

    10/5/2010 6:06:32 AM |

    Please post the components of the complete lipoprotein panel that you suggest.  Thank you

  • CarbSane

    10/5/2010 12:54:06 PM |

    Obamacare is all about government controlling the type of medical care we receive.  It is dictating the type of insurance we are required to carry, and it is all about getting our information into the "system".  

    If I'm willing to pay for any diagnostic test, why can't I do this without a note from my doctor?  You can't in NY and California.  I see this spreading to other states rather than being repealed.  Too much freedom.

  • Anonymous

    10/6/2010 9:34:11 PM |

    I too would like to avail of an NMR cholesterol test in Europe, so would appreciate any information on where it is available.

    I also read a review recently (but can't find it now) of the NMR and VAP tests, dated 2009. The author concluded that there was little consistency between them and suggested that perhaps the technologies were not yet mature. Any thoughts on that?

  • Anonymous

    10/7/2010 4:53:04 AM |

    I think this kind of test is only available in USA

  • Prostatic Adenocarcinoma

    10/7/2010 12:37:34 PM |

    I am quite interesting in this topic hope you will elaborate more on it in future posts.

  • Anonymous

    10/8/2010 5:10:07 AM |

    Hi Dr. Davis,

    Would be useful to get your thoughts if there is any truth to the claims that NMR and VAP are too imprecise to be reliable...

    Thanks,
    David

  • health

    10/8/2010 10:23:38 AM |

    If you're looking to buy best protein powder (or related protein products) but not sure what to look for, this free expert-nutrition tutorial can help.

  • grandpa

    10/8/2010 11:57:08 AM |

    I went to direct labs but not sure which ones are the ones to order. Any suggestions? Thanks in advance.

  • Anonymous

    10/11/2010 6:23:39 PM |

    Which test do we order at Direct Labs?

    THANKS

  • TedHutchinson

    10/11/2010 7:11:02 PM |

    Sorry I forgot to mention Direct labs also do the VAP Cholesterol Test

  • Anonymous

    10/12/2010 3:55:25 PM |

    @ Ted,

    Is it possible to have a blood sample drawn in the UK and sent to these labs for analysis?

    Keep up the good work on your own blog!

  • TedHutchinson

    10/12/2010 5:34:16 PM |

    Is it possible to have a blood sample drawn in the UK and sent to these labs for analysis?
    Sorry the answer's NO.
    Pity as I'd really like a VAP test done.

    But while I was talking to them I asked if there was any time limit on this months Vitamin D special offer $39 testing.
    They said tests ordered this month at $39 would be valid for 6 months.
    So US readers could buy/use one now 2nd week in October, buy a second next week for use in 3 months time (January) and a third before the end of October for use before the end of April before six months is up.
    That way they would have a pretty good idea of just how much D3/DAILY their individual body requires to stay above 60ng/ml through the winter.
    Altered post to make avoid potential misunderstanding

  • Anonymous

    10/12/2010 8:22:21 PM |

    @ Ted,

    Thanks for that.

    Do you know of any advanced lipoprotein available in Europe? Any advance on the standard TC/TG/HDL/LDL would be great.

    Seems a bit mad to have to go to the US to get a good cholesterol test!

  • Anonymous

    10/12/2010 8:24:07 PM |

    That should read 'any advanced lipoprotein testing...'

  • Dr. William Davis

    10/12/2010 11:00:02 PM |

    Gentlemen--

    Sorry, but I know of no way in the U.K. to obtain lipoprotein testing.

    Should you discover some means please come back and let us know.

    You might consider contacting one of the lipoprotein testing companies, such as Liposcience, Atherotech, or Berkeley HeartLab. (All have websites with contact info.)

  • Dr. William Davis

    10/14/2010 2:25:13 PM |

    In response to the several questions re: what lipoproteins to obtain.

    We start with a lipoprotein analysis (LDL, HDL, and VLDL quantification and particle size). Some forms of lipoprotein testing require that you specify lipoprotein (a), if you are interested in obtaining that measure.

    There are measures, of course, outside of lipoproteins that are also important, e.g., thyroid measures, 25-hydroxy vitamin D, blood glucose/HbA1c, etc., all relevant to heart disease prevention.

  • Anonymous

    10/15/2010 10:08:32 PM |

    I too, like Ted, would like to have an advanced lipoprotien test,as I think my LDL may be a shade high for comfort. My numbers are:

    TC:  6.7 or 259
    TG:  1.05 or 41
    HDL: 1.23 or 48
    LDL: 4.99 or 193
    TSH: 3.77
    Glucose: 5.2


    The only dietary changes I have made in the last year were to take 4 Minami MorEPA softgels most mornings and markedly reduce but not eliminate carbs from my diet.

    Dr Davis, I have contacted Liposcience and NMR. Liposcience have no facility to test outside of the USA. NMR have not replied. I will retry NMR and also contact the other company you mentioned.

    I will post any information I receive, here.

  • Anonymous

    10/15/2010 10:14:44 PM |

    Correction:
    Atherotech responded, no reply from Liposcience.

  • Anonymous

    10/15/2010 11:56:08 PM |

    Correction No 2:

    TG:  1.05 or 93

  • Anonymous

    10/16/2010 12:19:36 AM |

    http://circ.ahajournals.org/cgi/content/full/119/17/2396

  • Anonymous

    10/19/2010 10:26:57 PM |

    Reply from Liposcience:

    Thank you for your inquiry and interest in the NMR LipoProfile test.  currently, the NMR LipoProfile test is only available in the US and performed in our laboratory in Raleigh, NC. Early next year, a laboratory platform will be launched to allow for expanded offering of the test outside the US.

    Thank you,

    LipoScience, Inc.

    PS  The link I posted in the last entry from AHA Journals, is the paper I found on the inaccuracies of advanced lipoprotein testing. That said, I'd still do the NMR test, if I could.

Loading
Is an increase in heart scan score GOOD?

Is an increase in heart scan score GOOD?

In response to an earlier Heart Scan Blog post, I don't care about hard plaque!, reader Dave responded:

Hello Dr Davis,

Interesting post about hard and soft plaque. I recently had a discussion with my GP regarding my serious increase in scan score (Jan 2006 = 235, Nov 2007 = 419).

After the first scan we started aggressively going after my LDL, HDL and Trig...196,59,221

And have them down to 103, 65, 92 - we still have a way to go to 60/60/60 [The Track Your Plaque target values]-

So the increase is a surprise, but my doctor said that the increase could in part be cause some of the soft plaque had been converted to hard plaque and the scan would show that conversion.



Dave's doctor then responded to him with this comment:

"Remember that although your coronary calcium score has gone up, this does not mean that you are at greater risk than you were a year ago. Remember that the most dangerous plaque is the not-yet calcified soft plaque, which will not show up on an EBT [i.e., calcium score]. It is only the safe, calcified plaque that can be measured with the EBT. [Emphasis mine.] For your score to go up like it did, while your lipids came down so much, what had to happen was that lots of dangerous unstable plaque was converted to stable, calcified plaque. There are no accepted guidelines for interpreting changes in calcium scores over time, because the scores tend to go up as treatment converts dangerous plaque to safer plaque. We do know that aggressively lowering LDL reduces both unstable and stable plaque, and we know that risk can be further lowered by adjuvant therapy such as I listed above."


Huh?

This bit of conventional "wisdom" is something I've heard repeated many times. Is it true?

It is absolutely NOT true. In fact, the opposite is true: Dave's substantial increase in heart scan score from 235 to 419 over 22 months, representing a 78% increase, or an annualized rate of increase of 37%. This suggests a large increase in his risk for heart attack, not a decrease. Big difference!

Dr. Paulo Raggi's 2004 study, Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy in 495 participants addresses this question especially well. Two heart scans were performed three years apart, with a statin drug initiated after the first scan, regardless of score.

During the period of study, heart attacks occurred in 41 participants. When these participants were analyzed, it was found that the average annual increase in score over the three year period was 42%. The average annual rate of increase in those free of heart attack was 17%. The group with the 42% annual rate of increase--all on statin drugs--the risk of heart attack was 17.2-fold greater, or 1720%.

The report made several other important observations:

--20% of the heart attack-free participants showed reduction of heart scan scores, i.e., reversal. None of the participants experiencing heart attack had a score reduction.
--Only 2 of the 41 heart attacks occurred in participants with <15% per year annual growth, while the rest (39) showed larger increases.
--The intensity of LDL reduction made no difference in whether heart attacks occurred or not. Those with LDL<100 mg/dl fared no better than those with LDL>100 mg/dl.

Dr. Raggi et al concluded:

"The risk of hard events [heart attack] was significantly higher in the presence of CVS [calcium volume score] progression despite low LDL serum levels, although the interaction of CVS change and LDL level on treatment was highly significant. The latter observation strongly suggests that a combination of serum markers and vascular markers [emphasis mine] may constitute a better way to gauge therapeutic effectiveness than isolated measurement of lipid levels."

This study demonstrates an important principle: Rising heart scan scores signal potential danger, regardless of LDL cholesterol treatment. Yes, LDL reduction does achieve a modest reduction in heart attack, but it does not eliminate them--not even close.

These are among the reasons that, in the Track Your Plaque program, we aim to correct more than LDL cholesterol. We aim to correct ALL causes of coronary plaque, factors that can be responsible for continuing increase in heart scan score despite favorable LDL cholesterol values.

So, Dave, please forgive your doctor his misunderstanding of the increase in your heart scan score. He is not alone in his ignorance of the data and parroting of the mainstream mis-information popular among the statin-is-the-answer-to-everything set.

Just don't let your doctor's ignorance permit the heart attack that is clearly in the stars. Take preventive action now.

Comments (30) -

  • Anonymous

    11/20/2007 5:41:00 PM |

    Dr Davis,

    What should Dave do?  He appears to have improved his LDL:HDL ratio as well as his total C to HDL ratio substantially, but his CAC score jumped significantly.  Maybe look at other risk factors?

    The info here gives no indication of median blood pressure for Dave.  LP(a)?  No indication of particle sizes. But, which of these or others would be most likely to be Dave's downfall in attempting to mitigate a future hard endpoint?

    I don't ask this lightly, I myself am trying to follow the TYP program and keep my high-for-my-age 29 CAC score from growning.  But, I'm frankly not looking forward to my rescan in about a year.  I'm a bit worried about the, "What if my scan shows a dramatic increase?  What then?"

    Thank you for the valuable information you provide.

    :LaughingCT

  • Dr. Davis

    11/20/2007 11:17:00 PM |

    I would urge Dave to follow all the principles of the Track Your Plaque program, including:

    1) Fish oil to provide minimum 1200 mg EPA + DHA per day

    2) Correction of all concealed lipoprotein patterns such as IDL and Lp(a)

    3) Vitamin D raised to 50 ng/ml--crucial!

    4) Normalization of blood pressure, including during exericse.

    5) Normal blood sugar (<100 mg/dl).

    Further efforts might be required, depending on the long-term effects on rate of plaque growth.

  • Ross

    11/21/2007 3:41:00 AM |

    My question is: how repeatable do you think the scores are on the CT scan?  Are they bulletproof (+/- 5% no matter where measured), consistent by analyst (+/- 5% with the same doctor analyzing the scan), or...?  

    I am currently visiting my brother in law, who is an FP doctor with a private practice.  One of his professional friends, a cardiologist who seems a cut above (thinks stenting is a cop-out), recently told him that he only trusted two centers in the mid-Ohio region to score a 16-slice CT scan accurately, and that even then, the variability was still too high for his taste.  Two numbers within 20% were within his expected error bars and weren't different enough to indicate any change to him.  Two different scan centers?  He wouldn't even compare the two scan scores.

    In my own job (software), I've had to manage human-measured numbers over and over again.  One observation keeps coming up: a single value doesn't mean much without an understanding of the accuracy of that value.  I really am curious about how you estimate confidence intervals on CT scan scores.

  • Dr. Davis

    11/21/2007 3:55:00 AM |

    Hi, Ross--

    Excellent questions.

    Several thoughts:

    1) 16-slice scanners are, unfortunately, prone to wider error in heart scan scoring, perhaps as much as 20%. The variation in scoring on an EBT or 64-slice device is far less.

    2) Variation from scan to scan, when expressed as percent, depends to a great degree on the score itself. Lumping all scores together, variation should be no more than 8-9%. However,a low score of, say 2, then repeated at 4 means 100% variation. However, the same absolute difference of 2 but with a score of 1002 and repeated at 1004 is <1% variation. Therefore, higher scores assume much less percent variation, usually <5%.

    3) Variation among different reading physicians tends to be a minor issue, since much of the scoring is done by standard criteria determined by software, not the human eye. The only real source of human variation comes from disputable areas, such as the mitral valve (which can sometimes encroach into the coronary area and appear like plaque) and the mouth of arteries, which can be debated as being in the aorta or in the coronary arteries themselves. However, these disputable areas are issues in <5% of scans.

  • Tom

    11/21/2007 4:30:00 AM |

    It's interesting that a 29 year old is able to track his plaque. I'm in my 60's now and recently found your site AFTER bypass surgery and a calcium score >700 via a 64 slice scan.
    In reading past comments, those of us having had the heart procedure are now unable to follow our progress via the cac score. Until this post I had hoped to use your recommended blood tests for indication of progress, but if LDL reduction achieves a modest risk reduction, we are left without a specific guide.
    Question: Was the progress in blood tests in dave's case a result of statins ?

  • Dr. Davis

    11/21/2007 12:46:00 PM |

    That's why lipoproteins are so important--they provide other indicators. In my experience, people who have LDL cholesterol as the sole cause of heart disease are a very small minority. The vast majority of people have multiple causes beyond LDL.

    Also, about 50% of people can still get a heart scan score after bypass surgery if you find a center willing to do a detailed analysis. You will need to ask.

    Also, I don't know what Dave did, since he is a reader and everything he posted is above. Are you there, Dave?

  • Dr. Davis

    11/21/2007 5:41:00 PM |

    Hi, Paul--

    I think your doctor might be confusing heart scans with CT coronary angiograms. She is right in saying that CT angiograms (using X-ray dye) require a lot of radiation; 100 chest x-rays worth with present technology.

    However, a plain heart scan to generate a heart scan score requires 4 chest x-rays worth on an EBT device, 8-10 on an 64-slice multi-detector device.

    See the Track Your Plaque Special Report, Radiation and Heart Scans: The Real Story at http://trackyourplaque.com/library/fl_06-021radiation.asp.

  • Anonymous

    11/21/2007 6:01:00 PM |

    Regarding repeatability, there is a 2005 study by Serukov, Bland, and Kondos that shows that the repeatability is a function of the square root of the calcium score, and that volume score is more repeatable than Agatston score. The reference is

    “Serial Electron Beam CT Measurements of Coronary Artery Calcium: Has Your Patient's Calcium Score Actually Changed?” Alexander B. Sevrukov, J. Martin Bland and George T. Kondos, American Journal of Roentgenology 2005; 185:1546-1553
    http://www.ajronline.org/cgi/content/full/185/6/1546

    In this report, the standard deviation of the difference between two sequential calcium scored is

    SDAG130 = 2.515 *sqrt(avg score)
    SDVol130 = 1.758 *sqrt(avg score)

    This results in the following values, where SDA is the standard deviation for the Agatston score and SDV is the standard deviation for the volume score.

    Score-SDA--%SDA--SDV--%SDV
    5-----5.62---112%---3.93--79%
    10----7.95---79%----5.55--56%
    20----11.2---56%----7.86--39%
    50----17.7---35%----12.4--25%
    100---25.1---25%----17.5--18%
    200---35.5---17%----24.8--12%
    300---43.5---14%----30.4--10%
    400---50.3---12%----35.1---9%
    500---56.2---11%----39.3---8%
    600---61.6---10%----43.0---7%
    700---66.5----9%----46.5---7%
    1000--79.5----7%----55.5---6%

    These values show why many people use 15% as a breakpoint - only if the score has changed by more than 15% can it be said that the change is real. And this is only true for scores above 200 or so.

    Harry

  • Anonymous

    11/21/2007 7:17:00 PM |

    My cardiologist told me that EBT scanning is not recommended for anyone under the age of 30. Is this true? If so, how do I (29 years) reliably know that I am at risk?

    I discovered your blog recently. Since I have a very bad family history of diabetes, high blood pressure, and cholesterol, I decided to visit a cardiologist last month so that I can request for an EBT scan. He said that I'm too young for that, and has instead asked me to take a Carotid IMT and Stress test - are these tests reliable enough to provide insight on my risk? Could these tests return "false positive" values?

    I had found during a blood test I did this July only to find that my triglycerides were at 600!! The other cholesterol values were bad too - totalC-HDL-LDL-Tri (255-31-Not measurable-600)

    Since then I have found your blog, lost around 25 lbs and did a VAP recently (I asked for NMR and all I got from doctors - what? What the heck is that?) So I settled for a VAP, since they knew about it.

    I did a VAP along with a comprehensive blood test and the measures that came up high were.

    LIPID related:
    Total LDL-C Direct:130 (Normal<130)
    Real LDL-C:110 (N<100)
    Sum Total LDL-C: 130 (<130)
    Remnant LIPO (IDL+VLDL3): 30 (<30)
    HDL-2:9 (>10)
    VLDL3: 14 (<10)

    Non-LIPID related high values:
    Uric Acid: 8.3  (4.0-8.0)
    Fasting Glucose: 104 (65-99)
    Creatine Kinase Total: 631 (<=200)


    LP PLA2 is normal: 164 (115-245)
    HBA1C suggests prediabetic: 5.7 (Normal <6%)


    Due to my very high value of CK Total, I researched online and found that this can increase due to high exercise, and I had it repeated after taking rest, and it returned normal results. My doctor was really surprised about this and initially hesitant to fractionise my CK. I feel empowered that I am able to take charge of my health and preventative care with the
    information that is available online (of course, one needs to tread that carefully and make an informed decision due to various conflicting opinions out there).

    Sorry for the long post, Doc. I have a newfound awareness of my health thanks to your blog, and am very much interested in knowing your inputs. I just hope that more physicians in our country follow your noble path and understand the true value and empowerment of preventive care.

    - Philip

  • Dr. Davis

    11/21/2007 8:09:00 PM |

    Hi, Philip--

    In general, 29 is very young, perhaps too young, unless there is an outstanding family history (e.g., father with heart attack at age 37). Although your lipid/lipoproteins are concerning, it would be highly unusual to have anything but a zero heart scan score at your age.

  • Dr. Davis

    11/21/2007 8:14:00 PM |

    Hi, Harry--
    Thanks for the help!

  • Neelesh

    11/22/2007 4:51:00 AM |

    Hi Dr. Davis,
      I've just bought the Track Your Plaque book, waiting for its arrival. I've had a heart attack a year back.I'm 30 years old with no family history, non-alcoholic, non-smoker and vegetarian.
    The event was attributed to ectatic arteries(Type-III) and a very high level of LP(a)- between 120-130. The standard lipid profile was also marginally higher. If I had not insisted for an LP(a) test after reading Dr Agatston's South Beach Heart Program, I would have never found the LP(a) factor.
       I was stented during the hospitalization and now I'm wondering how effective the heart scan will be, given that the accuracy reduces  with stented arteries (http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_692-a)

    Thanks!
    -Neelesh

  • Dr. Davis

    11/22/2007 2:35:00 PM |

    Hi, Neeleesh--

    I do advocate heart scanning in people with stents, but I generally suggest that only the unstented arteries be scored. It's imperfect, excluding the most diseased artery, but it's proven a useful compromise, leaving you with two "scorable" arteries.

    The study you cite, however, is not about heart scans, it's about CT coronary angiography, a study that yields "percent blockage" sort of information, not an index of plaque.

    Beyond Lp(a), you should strongly consider vitamin D normalization.  By your first name, I take it you are from India/Pakistan or similar background, an ethnic origin that is associated with severe vitamin D deficiency.

  • Neelesh

    11/22/2007 3:00:00 PM |

    Thanks Dr. Davis. And yes, I'm from India.

  • wccaguy

    11/22/2007 3:13:00 PM |

    Dr. Davis,

    I found your answer to Neeleesh to be interesting in the extreme.  I have a  follow up question to it.

    I don't have specific references for the two facts I have heard but couldn't reconcile:

    1   India has high coronary artery disease incidence.

    2   Your answer to Neeleesh states that vitamin d levels are low in India and Pakistan.  And that would help much to explain the high rate of coronary artery disease in these countries.

    3   And yet India is close to the equator and so vitamin d levels should be relatively high because of sun exposure right?

    The question then is this:  What is the cause of the low vitamin d level in those countries?

    Thanks!

  • Dr. Davis

    11/22/2007 4:00:00 PM |

    It is interesting, isn't it?

    I believe part of the explanation is that, the darker your skin complexion, the more you are "protected" from intense and prolonged sun exposure. But, activation of 7-hydrocholesterol to 25-OH-vitamin D3 may require many hours more exposure. Thus, a fair skinned person might activate D within minutes, while a dark skinned individual might require hours.

    Another factor that has not been thoroughly explored but has potential for yielding enormous insights: Vit D receptor genotypes. That is, vitamin D deficiency may express itself in different ways in different populations. Some might get colon cancer, others multiple sclerosis, others coronary disease.

    I believe that the dark-skinned phenomenon becomes especially an issue when migrating to sun-deprived climates such as the northern U.S.

  • wccaguy

    11/22/2007 6:12:00 PM |

    Hi Doc,

    Your explanation makes sense.

    I did a quick google search and found experts on the problem in India attributing it to the increasing extent to which Indians were staying indoors and not "being active."

    But the vitamin D issue throws the whole question of "activity" into question doesn't it?  It might not be the activity per se but instead the amount of sunlight reduction.

    And if, per your explanation, darker skinned people need more time in the sun than lighter skinned people for Vitamin D3 to be "activated" then than a decrease in sunlight would have more effect on darker skinned people than lighter skinned people.

    Very interesting...  And perhaps INCREDIBLY good news!!!

    Because it means that there might be a cheap effective treatment for the coronary disease epidemic in India.

    Does all that make sense?

  • wccaguy

    11/22/2007 6:19:00 PM |

    Just to follow up one more point on this D3 question...

    I guess what we need to do is find a study which shows a correlation between degree of skin pigmentation and Vitamin D3 activation?

    (I'm not sure if the word "degree" is the right word, but perhaps the question is understood anyway?)

    Answering that question would certainly set up the basis for a scientific study right?

  • Dr. Davis

    11/23/2007 12:56:00 AM |

    Yes, it does. It could serve as the basis for a tremendously interesting study.

  • Dr. Davis

    11/23/2007 1:09:00 AM |

    There are indeed a few studies that document this effect, e.g., Factors that influence the cutaneous synthesis and dietary sources of vitamin D (abstract viewable at Arch Biochem Biophys. 2007 Apr 15;460(2):213-7.)

    However, I am not aware of any study that examines the effect of vitamin D supplementation specifically in this population that tracks coronary atherosclerosis. One British study  in Bangladeshi adults did demonstrate dramatic reduction in inflammatory markers with vit D replacement (Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12454321&ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum  ).

  • Dave K

    11/24/2007 12:21:00 AM |

    Hi Dr Davis,

    Sorry - I have been offline for a couple of days.  Interesting discussion.  I will try and add some detail lipid info.

    July 2007 Blood work showed

    My Lp(a) is 7
    IDL = 10
    VLDL=11
    HDL-2 = 15
    HDL-3 = 50
    VLDL C = 18
    VLDL1+2 = 7

    Currently taking fishoil 1700 mg of DHA+EHA
    Vitamin D 800mg - just incresed to 2000
    Baby Aspirin
    Multivitamin
    Crestor
    Just started Zetia after getting this last scan result
    Eat basic South Beach phase 3
    BMI - 27
    Glucose is 105
    Exercise 4X week...
    Lp-PLA2=120

    Blood pressure high-normal but I don't know about during exercise.  Cardilogist scheduled me for a stress test after this volume increase.

    I have not has a blood test for Vit D.

    Also - I had an angiograham after the first scan because I was having chests pains .... it turned up that I had no blockages whatsoever.  So we judged the chest pains as non cardiac.

    So I am following your list pretty close.  I guess I just have to wait to see how these changes do.  How long would you wait for another scan?

    Not sure what else to add - your website says to consider L-arginie...


    I do have a specific question.  In the scan report it shows where the calcium was found.  Don't know the software, but there was one spot where it showed in the early report that it didn't show in this report (of course there was several new areas) - could that have actually been a reversal at that spot?

  • Dr. Davis

    11/24/2007 1:25:00 AM |

    Small LDL and a deficiency of large HDL, along with modest excess weight, high blood sugar, high blood pressure all suggest you are (or were) likely over-dependent on processed carbohydrates like wheat products. Your pattern would likely respond vigorously to reduction or elimination of these foods and weight loss. Niacin can help this pattern. In our experience, normalization of vitamin D is crucial.

  • Dave K

    11/26/2007 5:51:00 AM |

    Dr Davis,

    Few more data ....

    Some of the treatments have only been for the last 6 months or so.  The Statin was first (of course) and it took almost a year to get something I could tolerate.  The we talked about Vit D (700) and fish oil (800 Omega 3).  After a full Lipid scan around 9 months ago - we decided to add more fish oil.  So the full dosage I listed is only 6 months old or so.

    Also - I love my red wine and I know the number says two glasses and i rarely do two - so its three or four ... which might be my next step....

    From your last response, I assume the VLDL and IDL levels are the ones you would target hardest at this point.

    Don't do a lot of sugar or wheat... Do eat Oatmeal everyday with rasins or blueberries.

    Oh and my other question was with this kind of increase how long would you wait for the next scan?

  • Dr. Davis

    11/26/2007 12:08:00 PM |

    Dave-

    I generally recommend waiting a year after all identifiable causes have been corrected. However, given your minimal doses of vit D, I usually have my patients wait at least six month after vitamin D blood levels are corrected.

  • Dave

    11/26/2007 8:01:00 PM |

    Dr Davis,

    Thank you ... keep up the great work and I'll keep reading... and tracking.

    Dave

  • G

    11/27/2007 12:39:00 AM |

    Neeleesh and DR. D,

    This Canadian physician appears to have a lot of indepth awareness of the diff phenotypes. He suggests (in the author's response) that D2 may not work as well in East Indians (may worsen glycemic control) versus D3 (the more biologically active vitamin D). Very fascinating!!

    http://www.cfp.ca/cgi/reprint/53/9/1435
    Repletion of vitamin D with vitamin D2 is common
    practice, and vitamin D2 can be used safely when monitored
    to achieve normal levels of 25(OH)D. This might
    take 2 to 3 months, as discussed in your letter and in my
    paper, because the half-life is about 2 weeks. Using vitamin
    D3 (1000 to 5000 IU) daily, depending on the level
    of deficiency, will also achieve this goal. I also agree
    that the goal is to achieve levels of 25(OH)D higher than
    100 nmol/L, preferably 100 to 125 nmol/L.
    My concern regarding vitamin D2 is that it is a synthetic
    analogue and might interact with the vitamin D
    receptor differently in various cell systems. It has been
    reported that vitamin D3 might improve glycemic control.
    7 Vitamin D2 has been reported to cause worsening
    of glycemic control in people of East Indian descent.8
    Is this because of vitamin D receptor polymorphism, or
    because of enhanced 24-hydroxylase enzyme activation,
    or is it due to how vitamin D2 interacts with the receptor?
    Until this has been sorted out, I feel safest using
    vitamin D3. There are about 2000 synthetic analogues
    of vitamin D. The search is on for one that can cross the
    blood-brain barrier to treat certain types of brain cancers
    without causing hypercalcemia.9 But then again,
    what other effects would this compound have? There
    are still so many unknowns.
    The first step is to recognize that most Canadians
    do not get enough vitamin D, especially in the winter
    months, because of where we live. This recognition
    might reduce the need for expensive drugs to treat
    various conditions and might improve the well-being of
    many Canadians.
    An ounce of prevention is worth a pound of cure.
    —Gerry Schwalfenberg MD CCFP
    Edmonton, Alta
    by e-mail

    here's the orig article which is one of the most excellent summaries I've seen so far -- great minds think alike -- they advise > 50ng/ml like DR. Davis as well!
    http://www.cfp.ca/cgi/reprint/53/5/841

  • Neelesh

    11/27/2007 4:05:00 AM |

    D,
    Interesting study indeed. Thanks for the information. I guess I have a lot of things to discuss with my cardiologist next week. Smile
    -Neelesh

  • chickadeenorth

    12/2/2007 11:16:00 PM |

    Hi to Gerry Schwalfenberg MD CCFP, do you know any Dr In Edtmn who practices Track your Plague, if so could you suggest names to help me. I live out by Jasper and need a skilled Dr in this treatment program, I would travel to Edtmn.Many thanks.
    chickadeenorth
    (hope its ok for me to ask this here)

  • cadoce66

    4/5/2008 8:37:00 PM |

    hi my aunts 63 yrs and she underwent an angioplasty with a medicated stent .. Shes on PLAVIX and her artery was 90% blocked and she had an evolving AWMI...
    Please advise what she should taketo prevent another blockage or heart attack!
    Thanks!

  • buy jeans

    11/3/2010 10:34:10 PM |

    So, Dave, please forgive your doctor his misunderstanding of the increase in your heart scan score. He is not alone in his ignorance of the data and parroting of the mainstream mis-information popular among the statin-is-the-answer-to-everything set.

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Triglycerides: What is normal?

Triglycerides: What is normal?

In The Track Your Plaque program, we advocate decreasing triglycerides to 60 mg/dl or less.

That's the level of triglycerides that minimize the presence of triglyceride-containing undesirable lipoproteins causing plaque, such as small LDL, VLDL, and the after-eating persistence of IDL (intermediate-density lipoprotein, a bad player). (The enzyme, cholesteryl-ester transfer protein, or CETP, is responsible for exchanging one triglyceride molecule for one cholesterol molecule between HDL and other lipoprotein particles. Thus, an excess of triglyceride availability permits CETP to operate unrestrained, creating more undesirable lipoproteins. This was the basis for Pfizer's now defunct CETP inhibitor, torcetrapib.)

Of course, this triglyceride target is far below that of the conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests a triglyceride level of 150 mg/dl is okay.

In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth. In short, triglycerides of 150 are awful.

Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl.

We have seen many people drop their heart scan scores just by achieving a triglyceride level of 60 mg/dl or less. So achieving a lower level below 60 is not necessarily a requirement for coronary plaque regression.

But it makes me wonder if a triglycere level of 30s or 40s is the level for perfect health. These are levels ordinarily regarded as impossibly low. When colleagues see the numbers we readily and routinely achieve, they declare that the numbers are spurious, temporary, or just flukes. "No way you can do that all the time!"

This level also seems to, in virtually all cases, eliminate the triglyceride-containing undesirable lipoproteins small LDL, IDL, etc., and allow full conversion of HDL into the healthy, large fraction.

Should we move the Track Your Plaque triglyceride target to below 45 mg/dl or even lower? I don't think so, but it makes me wonder.

Comments (2) -

  • Emily

    11/29/2010 10:43:23 PM |

    interesting. i recently had my cholesterol levels checked and had triglyceride levels of 46, perfect? on the other hand, my ldl is 166, but this is from the standard test, not calcuated/measured the way you suggest. hdl is 73 and vldl 9, which i think is pretty low and good? i find this info confusing but am happy that my doctor recomended niacin and fish oil and cod liver oil rather then drugs.

  • Yvonne

    12/15/2010 8:23:58 AM |

    Just got results from cholesterol screening and Triglycerides are 32That sounds so low to me.  Hdl is 71 and Ldl is 173. I have been off of Lipitor for 6 months to see is I could bring down bad Ldl.  My doc wants me to go back on Lipitor (10 mgs).  Why are triglycerides are so low is a mystery.  They have been running 65-70 while I was on Lipitor.

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